1. Collaboration The Key to Interoperability Chuck Meyer Chair, HL7

2. 2 Interoperability Collaborative The Interoperability Collaborative coordinates member activities to overcome obstacles in the progression towards global interoperability. It encompasses: Healthcare informatics standards (HL7) Standards adoption/implementation (IHE) Product delivery and tools for interoperability (EHRVA)

3. 3 Interoperability Collaborative HL7 = Standards Development Develops healthcare informatics standards for messaging and document exchange; key components of IHE integration profiles Meets national use cases Ensures international consensus

4. 4 Interoperability Collaborative IHE = Integration Identifies critical use cases Specifies integration profiles Publishes technical framework Tests implementation via Connectathons Engages vendors via product integration statements

5. 5 Interoperability Collaborative EHRVA = Advocacy and Tools Offers the Interoperability Roadmap Supports development of: –Standards –Integration Profiles Fosters member awareness and development of interoperable products

6. 6 The EHRVA Interoperability Roadmap Internet HIS to HIS Document Sharing Dynamic Information Management Transactions Clinical Content Resource Locator Services Security and Identity Persistent Info Documents Dynamic Information Access WorkflowQuality Patient and Provider ID Mgmt Access Control Medical SummariesLab Results Radiology MedicationsAllergiesProblems Notifications (ePrescribing, Lab Ordering etc.) Quality & Public Health Reporting HIS to NHIN Scanned Document Clinical Specialties HL7 Reference Information Model

7. 7 Linking the EHRVA Roadmap to Profiles and Standards Internet HIS to HIS Document Sharing Dynamic Information Management Transactions Clinical Content Resource Locator Services Security and Identity Persistent Info Documents Dynamic Information Access WorkflowQuality Patient and Provider ID Mgmt Access Control Medical SummariesLab Results Radiology MedicationsAllergiesProblems Notifications (ePrescribing, Lab Ordering etc.) Quality & Public Health Reporting HIS to NHIN Scanned Document Clinical Specialties HL7 Reference Information Model IHE CT, ATNA, XUA IHE PIX, PDQ HL7 V2, V3 Patient Admin HL7 Consent Docs IHE Axs Consent

8. 8 Linking the EHRVA Roadmap to Profiles and Standards Internet HIS to HIS Document Sharing Dynamic Information Management Transactions Clinical Content Resource Locator Services Security and Identity Persistent Info Documents Dynamic Information Access WorkflowQuality Patient and Provider ID Mgmt Access Control Medical SummariesLab Results Radiology MedicationsAllergiesProblems Notifications (ePrescribing, Lab Ordering etc.) Quality & Public Health Reporting HIS to NHIN Scanned Document Clinical Specialties HL7 Reference Information Model IHE CT, ATNA, XUA IHE PIX, PDQ HL7 V2, V3 Patient Admin HL7 Consent Docs IHE Axs Consent IHE XDS IHE XDS-MS HL7 CDA CRS, CCD HL7 CDA Lab & Path HL7 CDA Rad Report HL7 CDA +PDF, TIFF HL7 CDA Anest., Peds. IHE XDS-I IHE XDS-Sc IHE XDS-zz IHE XDS-Lab

9. 9 Linking the EHRVA Roadmap to Profiles and Standards Internet HIS to HIS Document Sharing Dynamic Information Management Transactions Clinical Content Resource Locator Services Security and Identity Persistent Info Documents Dynamic Information Access WorkflowQuality Patient and Provider ID Mgmt Access Control Medical SummariesLab Results Radiology MedicationsAllergiesProblems Notifications (ePrescribing, Lab Ordering etc.) Quality & Public Health Reporting HIS to NHIN Scanned Document Clinical Specialties HL7 Reference Information Model IHE CT, ATNA, XUA IHE PIX, PDQ HL7 V2, V3 Patient Admin HL7 Consent Docs IHE Axs Consent IHE XDS IHE XDS-MS HL7 CDA CRS, CCD HL7 CDA Lab & Path HL7 CDA Rad Report HL7 CDA +PDF, TIFF HL7 CDA Anest., Peds. IHE XDS-I IHE XDS-Sc IHE XDS-zz IHE XDS-Lab IHE Transactions HL7 V3 Meds, Pt Care IHE DynQ Med-All-Pb

10. 10 Linking the EHRVA Roadmap to Profiles and Standards Internet HIS to HIS Document Sharing Dynamic Information Management Transactions Clinical Content Resource Locator Services Security and Identity Persistent Info Documents Dynamic Information Access Workflow Quality Patient and Provider ID Mgmt Access Control Medical SummariesLab Results Radiology MedicationsAllergiesProblems Notifications (ePrescribing, Lab Ordering etc.) Quality & Public Health Reporting HIS to NHIN Scanned Document Clinical Specialties HL7 Reference Information Model IHE CT, ATNA, XUA IHE PIX, PDQ HL7 V2, V3 Patient Admin HL7 Consent Docs IHE Axs Consent IHE XDS IHE XDS-MS HL7 CDA CRS, CCD HL7 CDA Lab & Path HL7 CDA Rad Report HL7 CDA +PDF, TIFF HL7 CDA Anest., Peds. IHE XDS-I IHE XDS-Sc IHE XDS-zz IHE XDS-Lab IHE Transactions HL7 V3 Meds, Pt Care IHE DynQ Med-All-Pb HL7 V3 Meds, Orders, Lab IHE Lab RT WF ePrescribe NPRM

11. 11 Linking the EHRVA Roadmap to Profiles and Standards Internet HIS to HIS Document Sharing Dynamic Information Management Transactions Clinical Content Resource Locator Services Security and Identity Persistent Info Documents Dynamic Information Access WorkflowQuality Patient and Provider ID Mgmt Access Control Medical SummariesLab Results Radiology MedicationsAllergiesProblems Notifications (ePrescribing, Lab Ordering etc.) Quality & Public Health Reporting HIS to NHIN Scanned Document Clinical Specialties HL7 Reference Information Model IHE CT, ATNA, XUA IHE PIX, PDQ HL7 V2, V3 Patient Admin HL7 Consent Docs IHE Axs Consent IHE XDS IHE XDS-MS HL7 CDA CRS, CCD HL7 CDA Lab & Path HL7 CDA Rad Report HL7 CDA +PDF, TIFF HL7 CDA Anest., Peds. IHE XDS-I IHE XDS-Sc IHE XDS-zz IHE XDS-Lab IHE Transactions HL7 V3 Meds, Pt Care IHE DynQ Med-All-Pb HL7 V3 Meds, Orders, Lab IHE Lab RT WF ePrescribe NPRM HL7 V2, V3 Pub. Health Rep. CDC Imp Guide

12. 12 Credit Where Credit Is Due My thanks to Charles Parisot [GE, IHE] and Liora Alschuler [Alschuler Associates, HL7] for their work developing the slide mapping profiles and standards to the EHRVA Interoperability Roadmap.

13. HL7 and ASTM Collaboration The Continuity of Care Document

14. 14 HL7 CDA Clinical Document Architecture –ANSI/HL7 R1-2000, R2-2005 eDocuments for Interoperability –Key component for local, regional, national electronic health records –Gentle on-ramp to information exchange Everyone uses documents EMR compatible, no EMR required All types of clinical documents

15. 15 ASTM CCR A core data set of the most relevant administrative, demographic, and clinical information facts about a patients healthcare, covering one or more healthcare encounters.

16. 16 CCR vs. CDA Conflicting? Overlapping? Could we have both? –CCR data elements –CDA common exchange framework

17. 17 CCR + CDA = CCD CDA designed to support professional society recommendations, national clinical practice guidelines, standardized data sets, etc. From the CDA perspective, CCR represents a standardized data set providing constraints for specific summary document. The resulting specification, designated the Continuity of Care Document (CCD), will be the result of a collaborative effort between ASTM and HL7.

18. 18 Continuity of Care Document There is a history of collaboration –Presentation on CDA for continuity of care at ASTM, 2003 –Memorandum of Understanding, 2004 –Acapulco demo: CDA for CCR, October, 2004 –Initial HL7 Care Record Summary ballot, April, 2005: –As a result of HL7 ballot, Spring 2005: CCR incorporated changes required for bi-directional exchange and semantic interoperability

19. 19 Continuity of Care Document Current activities –Meeting ~ weekly by webinar, teleconference –Sample lab section developed as pattern –Participation by: ASTM E31.28 HL7 Structured Documents TC HL7 domain experts (patient care, lab, ED...) Clinical societies: ACP, AAFP, ACR... –Interest in international harmonization CDA summary documents in use around the world

20. 20 Continuity of Care Document Will CCD be adopted? Role of IHE –2005: Cross-enterprise document sharing (XDS) with both CDA and CCR –2006: XDS for Patient Care Coordination domain Medical Summaries CDA Care Record Summary Extend with coded content for three required sections –2007: likely adoption of CCD

21. 21 Continuity of Care Document Timeline –February – March: Meet by web/telconference Individuals developing: –Header –List of sections –Lab –Allergies/adverse reactions –Problems/conditions –Medications –April – May Initial ballot: header, list of sections, detailed sections Ballot reconciliation: Spring HL7 Working Group Meeting –June – July Develop complete draft for second ballot –August – September Second ballot Ballot reconciliation: Fall HL7 Working Group Meeting

22. 22 Continuity of Care Document Benefits –Industry consensus on summary document contents and requirements through ASTM ballots (2004, 2005) –Industry consensus on document exchange framework through HL7 ballots (1999-2005) –Summaries for continuity of care Interoperable with full range of document types Interoperable with HL7 V3 messages, all RIM- based specifications (public health reporting, clinical trials, structured product labels and more)

23. 23 Thank you for your time and attention. QUESTIONS?